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Anterior nasal packing [advanced]

Please note content is for educational purposes only and procedures should not conducted based on this information. OSCEstop and authors take no responsibility for errors or for the use of any content.

Introduction

  • Wash hands, Introduce self, Patients name, Explain procedure fully and get consent
  • Explain it will be uncomfortable and they may need to cough up blood pushed back down ā€“ give them a bowel

Gather equipment

Equipment list

  • 10% xylocaine spray (or 1% lidocaine in 2-5ml syringe sprayed fast from broken white needle)
  • Pack options
    • Nasal tampon (7.5cm ideal, also 5cm and 10cm available) e.g. Netcell nasal pack, Merocel
    • Inflatable pack (7.5cm ideal, also posterior pack available) Ā e.g. Rapid Rhino
  • KY jelly
  • 10ml syringe (filled with saline if using nasal tampon, or air if using inflatable pack)
  • Tape
  • Paper towels
  • Cardboard bowl

Preparation

  • Apply gloves and apron
  • Spray anaesthetic into nostril

Nasal tampon insertion

  • Ensure nasal tampon has a suture attached at one end (if not, place one)
  • Put KY jelly all over nasal pack
  • With your non-dominant hand, push up on the tip of their nose
  • Then immediately insert the nasal tampon into nostril horizontally in the sagittal plane (see image)
  • Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
  • The outer tip with suture attached should be next to the tip of the nose
  • Slowly expel the a few mls of saline from the syringe into the nostril to swell up the nasal pack like a tampon
  • Tape the string on their cheek
Nasal tampon insertion

Inflatable pack insertion

  • Remove pack from its sleeve
  • Place in bowel of sterile water (not saline) for 30 seconds
  • With your non-dominant hand, push up on the tip of their nose
  • Then immediately insert the inflatable pack into nostril horizontally in the sagittal plane (see image)
  • Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
  • The outer tip with suture attached should be next to the tip of the nose
  • Attach 10ml syringe full of air and inflate until pilot cuff is firm but with some bounce (no set volume)
  • Tape the tubing to their cheek

Further management

  • Full history and ABCDE assessment
  • Secure IV access and send bloods including FBC, G&S, clotting
  • Refer to ENT team for nasal cauterisation

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